Clinical Research Of Three Different Methods In Internal Fixation For Patellar Fractures

Objective:The aim of this article is to find out the biomechanical characters and therapeutic effects of the clinical application of the values of using three different methods in internal fixation for patellar fractures by comparing the internal fixation techniques of loop steel wirewith AO tension band,'TiNi shape memory alloy' for patellar fractures through clinical observation and follow-up visitation, and then, to provide some basis of theory and practice on selecting a kind of flexible, exact and effective method of internal fixation for treating patellar fractures in clinic in the future.Materials end Methods:Methods The clinical information of 86 patients was gathered in Hubei Provincial Hospital of TCM and Wuhan General Hospital of Guangzhou Command from May 1,2002 to Oct 1 2009. 52 cases of male,34 cases of female, all cases age from 17 to 73 years old (average 41 years old); 48 fractures occurred in left and 38 in right.84 cases of Fresh fractures,2 cases of old fractures.9 cases was open and 77 closed. 59 cases of transverse fracture of patella, 8 cases of longitudinal fracture,13 cases of comminuted fracture, 6 cases of sleeve fracture. 5 cases combining brain trauma,5 cases combining tibiofibular fractures,2 cases combining fracture of femurl,3 cases combining fracture of cubital eagle mouth. 2 cases combining multiple fracture. Much of fractures were made by the high-energy trauma,47 cases by traffic accident,22 cases during a fall onto the knee,7 cases by a direct blow and 10 cases by other reasons. The time of operation is 3h-12d after trauma, average for 3 days. 24 cases were treated by loop steel wire (Group A),26 by AO tension band (Group B) and 32 cases were treated by NT-PC (Group 0.86 cases' follow-up were available.Result:The time of follow-up varied from 6 months to 5 years. average was 2 years. In clinic, X-ray after operation and the knee joint recovery were analyzed consulting the criterion to evaluate therapy effect. Average healing of fracture was 12 weeks. There were no fracture displacement.1,Fixation intensity of the former Was a little worse than hat of the latter, but the stability of By comparing NT-PC With AO tension band and loop steel wire we found that internal the former was better. The intensity and stability of these three methods of internal fixation were good.2,4 cases applied loop steel wire failed because fracture fragment is too serious, then patella Was sewed up and the plaster immobilization were delayed. In the group of AO tension band, drug sensitive experiment was applied and, subsequently, antibiotic was used when 2 cases caught infection. 3 cases function practice were delayed because skin were disturbed by Kirschner wire. In the group of NT-PC,1 case of comrninuted fracture were serious involving quadriceps aponeurosis were destroyed badly,result in NT-PC superior branch came into the bone of patella. However, articular surface were not destroyed fortunately.Conclutions:1,Loop steel wire,AO tension band and NT-PC all could set the broken bone in internal fixation for patellar fractures, reach some excellent rate and were reasonable.2,The curative effect of AO tension band is similar to that of NT-PC in internal fixation for patellar fractures. Both AO tension band and NT-PC were better than Loop steel wire. They Meet the AO concept in the fixation for patellar fractures and had superior mechanical properties.It was useful of early function practice and reducing Late complications (especially the aged). At present, they are common method for patellar fractures.3,NT-PC was superior to Loop steel wire and AO tension band in exact fixation,simple operations,no external fixation,early function practice and recover. AO tension band was superior to Loop steel wire in recover of functionof joint, yet there had no significant difference in other ways. All three of these methods have their own advantages andshortcomings simultaneously. The surgeon should make their best choice according to the specific conditions,the kind of fracture and the patient Affordability etc.